Chronic Subdural Hematoma in Elderly Patients: Is This Disease Benign?

• Published in: Neurologia medico-chirurgica Vol. 57; no. 8; pp. 402 - 409
• Main Authors: HIRAI, Satoshi, TOI, Hiroyuki, UNO, Masaaki
• Format: Journal Article
• Language: English
• Published: Japan The Japan Neurosurgical Society 2017; Japan Science and Technology Agency
• Subjects: Age of Onset; Aged; Aged, 80 and over; Anesthesia; Anticoagulants; Benign; Blood; Brain; Brain Injuries, Traumatic - complications; Cerebral Hemorrhage - chemically induced; chronic subdural hematoma; Cognition Disorders - etiology; Cognitive ability; Consciousness Disorders - etiology; Craniotomy; Drainage; Dura mater; epidemiology; Female; Geriatrics; Hematologic Agents - adverse effects; Hematoma; Hematoma, Subdural, Chronic - complications; Hematoma, Subdural, Chronic - epidemiology; Hematoma, Subdural, Chronic - surgery; Hospital Mortality; Humans; Japan - epidemiology; long-term outcome; Male; Memory; Meninges; Patients; Population Dynamics; Recurrence; recurrence rate; Renal Dialysis - adverse effects; Review; Risk Factors; Surgery; treatment; Treatment Outcome; Urinary incontinence; Urinary Incontinence - etiology; long-term outcome; epidemiology; treatment; chronic subdural hematoma; recurrence rate
• DOI: 10.2176/nmc.ra.2016-0337
• ISSN: 0470-8105

As the world population becomes progressively older, the overall incidence of chronic subdural hematoma (CSDH) is increasing. Peak age of onset for CSDH has also increased, and recently the 80-year-old level has a peak. Many patients with CSDH have had prior treatment with anticoagulants and antiplatelet drugs, which have an accompanying risk of CSDH. In elderly patients with CSDH, symptoms of cognitive change (memory disturbance, urinary incontinence, and decreased activity) and disturbance of consciousness at admission were more frequent compared to younger patients with CSDH. The literature actually offers conflicting advice regarding CSDH treatment; however, burr hole surgery with drainage under local anesthesia is the most common surgical procedure, even in elderly patients. The recurrence rate of CSDH has not decreased over recent decades, and it has ranged from 0.36–33.3%. Outcomes in patients over 75 years old was significantly worse than for those younger than 75. Moreover, long-term outcomes for elderly patients with CSDH are poor. CSDH in the elderly is no longer a benign disease. In the future, it will be important for us to understand the mechanisms of onset and recurrence of CSDH and to develop more effective medical treatments and noninvasive surgical techniques for elderly patients.